Healthcare Provider Details

I. General information

NPI: 1982450946
Provider Name (Legal Business Name): TWC WENTZVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 WENTZVILLE PKWY STE 201
WENTZVILLE MO
63385-3553
US

IV. Provider business mailing address

1229 WENTZVILLE PKWY STE 201
WENTZVILLE MO
63385-3553
US

V. Phone/Fax

Practice location:
  • Phone: 636-327-8811
  • Fax:
Mailing address:
  • Phone: 636-978-0970
  • Fax: 636-978-7570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: AMBER BLUE
Title or Position: OFFICE MANAGER
Credential:
Phone: 636-978-0970